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Helen Hayes Hospital
Route 9W, West Haverstraw
NY 10993
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Patient Forms

The following forms are provided to help streamline the process for registering. Please print the forms for the department area that you will be receiving services and bring them with you on the day of your evaluation.

If you are receiving Tele-Health or Tele-Therapy services, the Consent for Tele-Health Services has been provided as a fillable PDF. Please download the form, fill it out on your computer, save and email the form to ACSSupervisors@helenhayeshosp.org.

 

Tele-Health Forms: These forms are for patients receiving Physician Tele-Health Clinic or Tele-Therapy services.

 

Outpatient Therapy Forms: please print, fill out, and bring to your evaluation

 

Bone Density: please print, fill out, and bring to your evaluation

 

Cardiac Rehabilitation: please print, fill out, and bring to your evaluation

 

Medical Doctors/Clinic: please fill out and email to ACSSupervisors@helenhayeshosp.org

 

Pulmonary Rehabilitation: please print, fill out, and bring to your evaluation

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